Provider Demographics
NPI:1972160737
Name:CARRASQUILLO, KAYLA B (MASTER OF SCIENCE)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:B
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 ROUTE 25A STE 9B
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2015
Mailing Address - Country:US
Mailing Address - Phone:631-325-7755
Mailing Address - Fax:
Practice Address - Street 1:6144 ROUTE 25A STE 9B
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2015
Practice Address - Country:US
Practice Address - Phone:631-325-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist